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“Think before you buy.” That seems easy for clothes or bottled water, but what about medical equipment? We as physicians have very little education in the decision-making that goes into procurement of medical equipment. There has been an ongoing debate in health care regarding reusable versus single-use (disposable) equipment, with multiple factors weighing on each side. As providers and users of these products, we need to learn more and involve ourselves with our administrators and management to advocate for more conscious purchasing. Multiple factors influence the decision-making process for procurement of reusable versus disposable equipment, including cost and work flow, environmental impact, safety profile and efficiency. While these are major factors that should frame the discussion for what equipment best fits the needs of each individual institution, decisions are often driven by convenience and resistance to change in work flow, rather than by cost, impact and safety. Here we will review the evidence that suggests, in most cases, reusable equipment and supplies are a more environmentally sustainable and cost-effective choice.